About 1.3 million people have Lewy body dementia, the Lewy Body Dementia Association estimate in the New York Times. However, aside from the symptoms associated with the diagnosis, even more challenges come from the dearth of understanding of the disease in many patients, caregivers--and sometimes doctors. The disease is often misdiagnosed as Alzheimer's, Parkinsons, or a different psychiatric disorder. More on Lewy body dementia: bit.ly/QUVOuQ, bit.ly/PWrQHF.

Published: 10/2/2012 10:03:00 AM

]]>Tue, 02 Oct 2012 10:03:00 GMT-05:00http://journals.lww.com/neurologynow/blog/breakingnews/pages/post.aspx?PostID=60http://journals.lww.com/neurologynow/blog/breakingnews/pages/post.aspx?PostID=59
By Olga RukovetsOn Sept. 12, the FDA approved teriflunomide (Aubagio), an oral, once-daily treatment for relapsing remitting multiple sclerosis in adults. After Novartis’ Gilenya, which was approved in 2010, teriflunomide is only the second oral MS treatment on the market. According to the FDA, a clinical trial showed the relapse rate for patients using teriflunomide at about 30 percent lower than the rate for those taking a placebo.With the approval, though, comes a stern black box warning from the FDA for doctors and patients to be aware of the possibility of deadly liver problems, as well as a risk of birth defects. Physicians should do blood tests to check liver function before a patient starts taking the medication, and periodically during treatment, the Agency said.For our previous stories on oral MS therapies (including teriflunomide), visit: http://bit.ly/x2xFRd. Look for coverage on the approval of teriflunomide in an upcoming issue of Neurology Today.

The widely used drug interferon beta does not seem to slow the progression of disability in patients with relapsing-remitting multiple sclerosis, according to a new Canadian study. A team of researchers from the University of British Columbia and UBC Hospital MS Clinic and Brain Research Centre at Vancouver Coastal Health did a retrospective cohort study to compare a group of MS patients taking interferon beta with two control groups from different periods in time that did not use the drug. “We did not find evidence that administration of interferon beta was associated with a reduction in disability progression in patients with relapsing-remitting MS,” the researchers reported in the July 18 issue of the Journal of the American Medical Association (JAMA). “The ultimate goal of treatment for MS is to prevent or delay long-term disability. Our findings bring into question the routine use of interferon beta drugs to achieve this goal in MS.” For the full-text and discussion of the use of interferon for MS, see the Sept. 6 issue of Neurology Today.

BY TOM VALEOPress accounts have called the failure of bapineuzumab to slow Alzheimer’s disease (AD) a blow to the quest to find an effective therapy. At press time, Pfizer and Johnson & Johnson, two sponsors of phase 3 trials of the drug, announced they would halt further trials of the agent for mild-to-moderate AD based on negative findings. But neurologists seem to regard the results of the phase 3 trials, released in July and August, as evidence that the drug, which clears amyloid protein from the brain, simply must be administered much earlier in the disease process. “The bapineuzumab phase 2 studies did not demonstrate a cognitive signal in their primary analyses, so it can’t be too surprising that phase 3 [trials] failed to establish efficacy,” said Paul Aisen, MD, a professor of neurosciences at the University of California, San Diego, and director of the Alzheimer’s Disease Cooperative Study, which is devoted to developing AD treatments. “The prevailing view in the field now is that anti-amyloid therapy should start much earlier than the dementia stage of disease,” said Dr. Aisen, who was not involved with the bapineuzumab trial. Read the full discussion from AD experts in the Sept. 6 issue of Neurology Today.

When the AAN issued its call for suggestions of neurology-related tests, procedures, and treatments that are frequently performed even though they are unnecessary, 80 neurologists submitted nearly 200 ideas.

As a participant in the new Choosing Wisely campaign, the AAN will use those suggestions to create a “Top Five” list of tests and procedures for neurologic disorders that physicians and patients should question. The campaign, launched earlier this year by the American Board of Internal Medicine (ABIM) Foundation, responds to the growing awareness that many common — but unnecessary — health care practices add to the nation’s health care costs and may even be dangerous to patients. For example, patients with simple faints often are referred for a carotid imaging study, said Gary S. Gronseth, MD, AAN’s evidence-based medicine methodologist.

"From a theoretical basis, carotid artery disease shouldn’t cause simple faints,” said Dr. Gronseth, vice chairman of the neurology department at the University of Kansas Medical Center, whose research focuses on evidence-based medicine. “But it’s commonly done, and if any symptomatic stenosis is found, patients are sent for surgery, and that may be inappropriate.”

Rod Larson, AAN’s chief health policy officer, said Choosing Wisely is a new way for the Academy to support its commitment to high-quality evidence-based care.

“The campaign is really geared toward generating better dialogue between patients and physicians and is intended to be a tool to be in addition to the clinical judgment of physicians,” he said. For more on the Choosing Wisely campaign and how neurology plans to contribute, see the Aug. 2 issue of Neurology Today.

Published: 8/8/2012 1:52:00 PM

]]>Wed, 08 Aug 2012 13:52:00 GMT-05:00http://journals.lww.com/neurologynow/blog/breakingnews/pages/post.aspx?PostID=56http://journals.lww.com/neurologynow/blog/breakingnews/pages/post.aspx?PostID=55
Picking Up Where the Drug Industry Left Off

BY JAMIE TALAN

Stroke, a condition that affects over 750,000 patients a year in the United States, is the fourth leading cause of death, and it remains a challenge for clinicians nationwide. The clot-busting drug, tissue plasminogen activator (tPA), is the only FDA-approved therapy for acute ischemic stroke. Since it came on the market in 1996, many other neuroprotective drugs have been tested but all failed to show efficacy in clinical trials. The result, according to NINDS Director Story Landis, PhD, and Deputy Director Walter J. Koroshetz, MD, is that the pharmaceutical industry has pretty much closed the door on developing stroke therapies. And it’s why the NINDS has made research in stroke a priority. According to Dr. Landis, 17 of 29 clinical trials supported by NINDS this year are in stroke.

Many of these have been comparative effectiveness trials, which have a major and immediate impact on medical decision-making. But NINDS also supports a number of epidemiological studies to better understand factors that put people at risk for stroke.

Going the Distance: Journeys of Recovery, by Emmy Award-winning filmmaker David L. Brown, is a harrowing but hopeful look at the “silent epidemic” of traumatic brain injury (TBI) in the United States. Each year, an estimated 1.7 million people sustain a TBI, according to the Centers for Disease Control and Prevention. Weaving together the stories of four survivors ranging in age and disability, the documentary is an honest and important peek into the world of people with TBI.

In his proposal for the film, Brown wrote poignantly: “An injury to the brain is an injury to the essentialself, which is why one of the film’s therapists explains that TBI survivors ‘have to reinvent who they are.’”

Going the Distance first introduces Jay Waller, an athletic Yale graduate. His plans of attending medical school are permanently sidelined when a brutal assault lands him in the hospital with little chance of survival. After rehabilitation, Waller looks nearly unaltered physically, making his cognitive disability even harder for him to accept. He also struggles with the verbal "disinhibition" (saying whatever comes to mind) that often results after a TBI.

We next meet Marine Jason Poole. Following an improvised explosive device (IED) blast in Iraq, he is comatose for two months and requires reconstructive facial surgery. An immensely social and handsome guy before the blast, Poole says he has trouble recognizing his new self in the mirror, and his fiancée does not remain with him post-injury.

The third person profiled in the film is Kristen Collins, an independent, young college student who is hit by a drunk truck driver while riding her motorcycle. Collins has to attend anger management classes after the accident to deal with a new part of her personality (anger is a common symptom in TBI survivors), and she feels trapped living at home with her parents again.

Last, we meet Ian McFarland, a 6-year-old boy and surf prodigy who survives an accident that kills both of his parents. His aunt Melissa graciously adopts him and his two siblings. His younger brother and sister sustained only slight injuries from the accident, while Ian suffered a TBI that leaves him impaired and in a wheelchair. The family is humbled by the support they receive from both friends and strangers.

Through these four people, “we witness how the medical and social safety nets are stretched thin: insurance companies are unwilling to pay for adequate treatment and TBI patients face stigma and ignorance from the general public and families struggle with ‘caregiver burnout’— there are simply not enough caregivers, resources or facilities to treat or even diagnose TBI,” Brown wrote in his proposal for the film.

The film takes us on a painful but triumphant journey with each of these survivors. Though some of their plans change as a result of TBI, we witness each of them achieve important goals by the documentary’s end. Waller enrolls in a Ph.D. program in physical therapy—a field he now knows first-hand. Poole is happily married and volunteering at the VA childcare center. Collins graduates from nursing school, as she had planned pre-accident. McFarland is making progress in both speech and mobility and gets back on a surfboard.

Although Brown chooses to focus on these stories of perseverance, he reminds viewers that not all TBI patients are so fortunate in their recovery, access to medical care, or social networks.

Brown has produced, written and directed over 80 productions and 11 broadcast documentaries on social, nuclear, environmental, health, technology, and peace and justice issues. His documentaries have received more than 80 international awards, including three Emmys, and have been broadcast on PBS and in 16 countries.

As the title implies, The Woman’s Migraine Toolkit is an all-in-one manual for migraineurs—packed with background information, questionnaires, worksheets, and exercises. For women of all ages, this book takes readers through the ins and outs of migraines—what might cause them, who gets them, and what can be done to prevent and treat them.

“Why me?” the first chapter asks, referring to the tough question posed by many migraineurs. But the book repeatedly reminds readers that roughly 30 million Americans live with migraineurs, and that they are neither alone nor without options.

Since migraines can start in young children, The Woman’s Migraine Toolkit follows the trajectory of these headaches from adolescence all the way through menopause, offering individualized details and advice along the way. It outlines their genetics, history, and complexities, as well as the questions you should be asking your doctor—and yourself.

Straightforward and complete with visuals for every chapter, the book offers a breakdown of available treatments, including drug and non-drug therapies, exercise, and diet. There are examples of stretches and physical exercises geared towards migraine-prone individuals with step-by-step photographic demonstrations of each.

The Woman’s Migraine Toolkit sheds light on several difficult topics, including migraines during pregnancy, hormones and migraine patterns, migraines and schoolwork, ensuring effective patient-doctor communication, talking to kids about migraines, and others.

In addition, TheWoman’s MigraineToolkit provides an extensive list of external resources such as websites, books, and trusted organizations for those with migraines and their families to access for more information.

Neurologist Dawn A. Marcus, M.D., of the University of Pittsburgh Medical Center, and Philip A. Bain, M.D., an internist from Madison, WI, have created a comprehensive guidebook for female migraineurs. Women at any stage of their lives can turn to this book for practical tips and advice on migraine management.

BETHESDA, MD—The goal of treating older patients at risk of developing Alzheimer’s disease while they are presymptomatic is moving closer to reality, according to speakers at a research meeting at the NIH here. If all goes as hoped, the Anti-Amyloid Treatment in Asymptomatic AD (A4) Trial, a secondary prevention trial, will be reviewed this summer and researchers will start screening subjects for eligibility in 2013.

The NIH meeting, Alzheimer’s Disease Research Summit 2012: Path to Treatment and Prevention, was hosted by the U.S. Department of Health and Human Services (HHS) and the National Institute on Aging (NIA) — funder of the A4 trial — with private support from the Foundation for NIH. The summit was one of the first steps in responding to the National Alzheimer’s Project Act, signed into law in January 2011. That law requires the HHS secretary to adopt and implement a national strategy for Alzheimer’s research and care.

Without such a strategy the number of Americans with Alzheimer’s is likely to balloon from 5.1 million today to 15 million by 2050, said NIH Director Francis Collins, MD, PhD, who opened the two-day event, noting that there is a “sense of optimism” emanating from recent scientific advances and opportunities.

Read about the promise and the concerns of conducting trials in presymptomatic patients in the June 21 issue of Neurology Today.

Continuous infusion of a levodopa gel into the small intestine beat out levodopa-carbidopa immediate-release (IR) tablets at reducing "off" time in patients with advanced Parkinson's disease (PD), without increasing dyskinesia.

That’s according to results of a phase 3 randomized, double-blind, double-dummy trial presented as part of the emerging science program at the American Academy of Neurology annual meeting in New Orleans in April.

"Levodopa is still the best drug we have [for Parkinson's disease], but after a long period of time, many patients develop motor complications, dyskinesias, during periods of response. Additionally, there is tendency of the drug to wear off, and Parkinson symptoms to return," said lead researcher C. Warren Olanow, MD, professor of neurology and neuroscience at Mount Sinai School of Medicine in New York.

"Patients begin cycling between periods when parkinsonism is controlled but there are involuntary movements and periods when parkinsonism is not controlled," he said. "A growing body of evidence suggests cycling occurs because levodopa is being restored in a non-physiologic way."

Dr. Olanow describes the study and experts provide commentary in the May 17 issue of Neurology Today.

NEW ORLEANS—Stroke patients in rural settings may benefit from specialty care with guidance from a vascular neurologist using the iPhone 4, according to a preliminary study presented at the 2012 American Academy of Neurology annual meeting here in April.

Studies have shown that stroke patients treated in rural hospitals are at increased risk of stroke-related morbidity and mortality because they are not likely to receive specialized care or intravenous (IV) tissue plasminogen activator (tPA) for acute treatment in those hospitals, explained poster author Eric Anderson, MD, PhD, a third-year resident at Emory University in Atlanta, GA. “Other studies have recently shown that IV tPA use is increased with use of teleneurology,” he added.

Current technology for telemedicine — which is recommended by the American Heart Association and American Stroke Association guidelines — traditionally involves a dedicated computer setup with separate video and audio equipment, which can be very costly and unattainable in areas where the need is greatest.

By contrast, the iPhone and other mobile “smart phones” are much less expensive, making it possible for a doctor in a remote or rural area to hook up with a vascular neurologist at a hub stroke center, he said. More on the use of smart phones for stroke care in the May 17 Neurology Today.

When it comes to helping epilepsy patients, there is much room for improvement — specifically, with providing timely referrals, correct diagnoses, and access to treatment, claims a comprehensive new report from the Institute of Medicine (IOM).

The IOM committee, which wrote the report, “Epilepsy across the Spectrum: Promoting Health and Understanding” — discussed at a news briefing on March 20.

The new report addresses the public health dimensions of epilepsy, not biomedical research. “This is a problem that is remarkably hidden for such a visible illness,” said IOM President Harvey V. Fineberg, MD, PhD, adding that epilepsy has been “too long neglected as a public health problem.”

Epilepsy is the fourth most common neurological disorder in the United States — after migraine, stroke and Alzheimer’s disease. An estimated 2.2 million Americans have epilepsy, with 150,000 new U.S. cases diagnosed every year; about one in 26 people will develop epilepsy at some time in their lives. The estimated US annual direct medical care cost of epilepsy is $9.6 billion, according to the report. To read more on the 13 recommendations to correct deficits in providing timely referrals, correct diagnoses, and access to treatment for epilepsy, see the May 3 issue of Neurology Today.

Although nearly 38 percent of migraineurs could benefit from preventative therapy, less than half of them currently use it, according to a 2007 study in Neurology. A new guideline on the treatment of migraines in adults, published in the April 24 issue of Neurology, asks: What are the effective pharmacologic and complementary medicine options for these individuals?

This guideline from the AAN Quality Standards Subcommittee and the American Headache Society is based on an analysis of studies conducted between 1999 and 2009; it updates a review released in 2000.

Lead author Stephen D. Silberstein, MD, professor of neurology and director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, PA, spoke with Neurology Today about what has changed in migraine care over the last decade, how he determines which therapies to use for individual patients, and where there is more need for research. Importantly, Dr. Silberstein said, “I think we’ve proven here once and for all that many drugs work for the treatment of migraines, not all the drugs work, and that there are options.” See the May 3 issue of Neurology Today for the full interview.

Genetic testing may hold answers to some of the unanswered questions behind autism. Although a unique blood test or brain scan cannot diagnose autism spectrum disorders, researchers are able to use symptoms and behavioral tests to guide them in their search for genetic causes, the Wall Street Journal reportedon Sept. 24. The American Academy of Pediatrics and the American College of Medical Genetics both recommend that all children diagnosed with autism spectrum disorders be tested for Fragile X Syndrome and other chromosome abnormalities, the article stated. What might these findings mean for diagnosis and treatments? See our archives: bit.ly/SzGCTK, bit.ly/O2Al5V.

A three-year pilot study, funded by Johnson & Johnson, will look at individuals with Down syndrome in an attempt to identify the early changes that bring about dementia — which occurs in as many as 3/4 of adults with Down syndrome, Reuters reported on Sept. 25. One concern, the article noted, is whether the parents of Down syndrome individuals will be willing to provide consent for these trials.

The association between Down syndrome and Alzheimer’s is not new: bit.ly/Qzbqa4.

There’s no question about it — the conversation on end-of-life care is a difficult one. But for those caregivers who find their loved ones in an ICU or incapable of expressing their final wishes — it becomes nearly impossible. One-fourth of elderly people die in an ICU, The New York Times reported in a story last week. A study published in Critical Care Medicine, looked at 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death in four intensive careunits and found that more than a quarter of the decision-makers werenot confident they understood what their relatives would want in this very situation. Many doctors, advocates, and family members are pushing to start the conversation earlier, in order to ensure that informed decisions are made with minimal stress. More on addressing end-of-life care: http://bit.ly/QX6vPi.

Fycompa (perampanel) tablets are approved for the treatment of partial onset seizures in epileptic patients over the age of 12, the U.S. Food and Drug Administration announced on Oct. 22. Partial onset seizures are the most common type of seizure in those with epilepsy. Perampanel is an AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor antagonist that works by reducing neuronal hyperexcitation associated with seizures by inhibiting glutamate activity at post-synaptic AMPA receptors. This is the first antiepileptic agent approved by the FDA to work in this manner, Eisai (the drug's manufacturer) said in a press release.

The medication includes a warning for prescribers and patients about risk of serious neuropsychiatric events, including irritability, aggression, anger, anxiety, paranoia, euphoric mood, agitation, and mental status changes—some potentially serious and life-threatening. The FDA said that a health care professional should be immediately notified of any atypical changes in mood or behavior. Patients should also be closely monitored during the titration period.

by Olga RukovetsOne retired surgeon, Paul Butler,is causing a stir in his community of Dover, NH—by proposing to end the football program at Dover High School, The New York Timesreported last week. His argument? Citing the class-action lawsuit filed in June against the N.F.L. on behalf of more than 2,000 former players, he said, if city officials won’t stop football at Dover High School, “the lawyers will do it for us.”

Read about the link between concussion and neurologic damage: bit.ly/SwSWbF. Let us know what you think: Should the future of football be in question?

Falls among individuals aged 65 and up are recognized to beone of the most common causes of injury death — but now a new study examines just how they occur, NPRreported recently. In The Lancet paper, the investigators used digital video to track falls in two long-term care facilities in British Columbia, and found that most of the 227 falls happened because of loss of balance — not due to slipping or tripping. The highest proportion of falls were associated with forward walking (54 falls, 24%), standing quietly (29 falls, 13%), and sitting down (28 falls, 12%). See our past coverage of how to reduce fall risk in the elderly: bit.ly/SeU1By.

Are we overmedicating our nation’s children? A question that has come under increased scrutiny as drugs like Adderall and other attention-boosting substances are prescribed more freely to younger individuals. The New York Times this week offered one controversial perspective on the subject — the idea of medicating children particularly in resource-poor and educationally disadvantaged environments where it is easier to “modify” the child than the society that surrounds him.

Should patients have access to their medical records? OpenNotes, a study which has allowed over 13,000 patients from three medical centers to have unfiltered access to one part of their medical records over the course of a year, is challenging some conventions and increasing transparency, as reported in today’s New York Times. The result? Enthusiasm from participating patients and doctors, who claimed the initiative increased trust and patient satisfaction. Other transparency initiatives: bit.ly/Pdbq1c, bit.ly/SFRWgy.

The new proposed definition of autism in the DSM-5 has sparked an ongoing debate among clinicians, patients, families, and patient organizations, about whether or not all individuals would continue to receive an appropriate diagnosis. A new analysis — the largest to date — published in The American Journal of Psychiatry, now reports that the proposed changes will only reduce the proportion of children diagnosed with autism by about 10 percent, the New York Timesreported. However, not everyone was convinced that these data could be translated into real world settings.

Read more on this debate: bit.ly/JYFyoz, bit.ly/A0PJky. And hear audio commentary from Dr. Thomas W. Frazier of the Cleveland Clinic Children’s Hospital Center for Autism and Center for Pediatric Behavioral Health: bit.ly/wfzqrG.

Delirium, sudden severe confusion and rapid changes in brain function that occur with physical or mental illness, is more common than you might think — and can be prevented in up to 40 percent of cases, the New York Times reported, if health professionals and patients’ families were aware of its causes and made changes to treatment accordingly. In elderly hospital patients (over the age of 65), delirium-related complications occur in at least one in five, and some individuals never fully recover. Yet, delirium often goes unnoticed and untreated.

Genetic testing may hold answers to some of the unanswered questions behind autism. Although a unique blood test or brain scan cannot diagnose autism spectrum disorders, researchers are able to use symptoms and behavioral tests to guide them in their search for genetic causes, the Wall Street Journal reportedon Sept. 24. The American Academy of Pediatrics and the American College of Medical Genetics both recommend that all children diagnosed with autism spectrum disorders be tested for Fragile X Syndrome and other chromosome abnormalities, the article stated. What might these findings mean for diagnosis and treatments? See our archives: bit.ly/SzGCTK, bit.ly/O2Al5V.

A three-year pilot study, funded by Johnson & Johnson, will look at individuals with Down syndrome in an attempt to identify the early changes that bring about dementia — which occurs in as many as 3/4 of adults with Down syndrome, Reuters reported on Sept. 25. One concern, the article noted, is whether the parents of Down syndrome individuals will be willing to provide consent for these trials.

The association between Down syndrome and Alzheimer’s is not new: bit.ly/Qzbqa4.

About 1.3 million people have Lewy body dementia, the Lewy Body Dementia Association estimate in the New York Times. However, aside from the symptoms associated with the diagnosis, even more challenges come from the dearth of understanding of the disease in many patients, caregivers--and sometimes doctors. The disease is often misdiagnosed as Alzheimer's, Parkinsons, or a different psychiatric disorder. More on Lewy body dementia: bit.ly/QUVOuQ, bit.ly/PWrQHF.

Published: 10/2/2012 10:03:00 AM

]]>Tue, 02 Oct 2012 10:03:00 GMT-05:00http://journals.lww.com/neurologynow/blog/breakingnews/pages/post.aspx?PostID=60http://journals.lww.com/neurologynow/blog/breakingnews/pages/post.aspx?PostID=59
By Olga RukovetsOn Sept. 12, the FDA approved teriflunomide (Aubagio), an oral, once-daily treatment for relapsing remitting multiple sclerosis in adults. After Novartis’ Gilenya, which was approved in 2010, teriflunomide is only the second oral MS treatment on the market. According to the FDA, a clinical trial showed the relapse rate for patients using teriflunomide at about 30 percent lower than the rate for those taking a placebo.With the approval, though, comes a stern black box warning from the FDA for doctors and patients to be aware of the possibility of deadly liver problems, as well as a risk of birth defects. Physicians should do blood tests to check liver function before a patient starts taking the medication, and periodically during treatment, the Agency said.For our previous stories on oral MS therapies (including teriflunomide), visit: http://bit.ly/x2xFRd. Look for coverage on the approval of teriflunomide in an upcoming issue of Neurology Today.

The widely used drug interferon beta does not seem to slow the progression of disability in patients with relapsing-remitting multiple sclerosis, according to a new Canadian study. A team of researchers from the University of British Columbia and UBC Hospital MS Clinic and Brain Research Centre at Vancouver Coastal Health did a retrospective cohort study to compare a group of MS patients taking interferon beta with two control groups from different periods in time that did not use the drug. “We did not find evidence that administration of interferon beta was associated with a reduction in disability progression in patients with relapsing-remitting MS,” the researchers reported in the July 18 issue of the Journal of the American Medical Association (JAMA). “The ultimate goal of treatment for MS is to prevent or delay long-term disability. Our findings bring into question the routine use of interferon beta drugs to achieve this goal in MS.” For the full-text and discussion of the use of interferon for MS, see the Sept. 6 issue of Neurology Today.

BY TOM VALEOPress accounts have called the failure of bapineuzumab to slow Alzheimer’s disease (AD) a blow to the quest to find an effective therapy. At press time, Pfizer and Johnson & Johnson, two sponsors of phase 3 trials of the drug, announced they would halt further trials of the agent for mild-to-moderate AD based on negative findings. But neurologists seem to regard the results of the phase 3 trials, released in July and August, as evidence that the drug, which clears amyloid protein from the brain, simply must be administered much earlier in the disease process. “The bapineuzumab phase 2 studies did not demonstrate a cognitive signal in their primary analyses, so it can’t be too surprising that phase 3 [trials] failed to establish efficacy,” said Paul Aisen, MD, a professor of neurosciences at the University of California, San Diego, and director of the Alzheimer’s Disease Cooperative Study, which is devoted to developing AD treatments. “The prevailing view in the field now is that anti-amyloid therapy should start much earlier than the dementia stage of disease,” said Dr. Aisen, who was not involved with the bapineuzumab trial. Read the full discussion from AD experts in the Sept. 6 issue of Neurology Today.